髋部骨折患者的主要口语语言与围手术期结局之间的关联
Associations Between Patients' Primary Spoken Language and Perioperative Outcomes After Hip Fracture.
作者信息
Yendluri Avanish, Restrepo Mejia Mateo, Stern Brocha Z, Laurore Charles, Busigo Torres Rodnell, Yacovelli Steven, Stocchi Carolina, Poeran Jashvant, Podolnick Jeremy D, Forsh David A
机构信息
From the Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai (Mr. Yendluri, Mr. Restrepo Mejia, Dr. Stern, Mr. Laurore, Busigo Torres, Dr. Yacovelli, Stocchi, Dr. Podolnick, Dr. Forsh); the Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY (Dr. Stern); and the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery (Dr. Poeran), New York, NY.
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 2;9(7). doi: 10.5435/JAAOSGlobal-D-25-00110. eCollection 2025 Jul 1.
INTRODUCTION
Recently, the role of a patient's primary spoken language (PSL) has emerged as a potential contributor to perioperative outcomes. This study aimed to identify the association between a patient's PSL and hip fracture perioperative outcomes, including hospital length of stay (LOS), in-hospital mortality, nonhome discharge, 30-day emergency department visits, 90-day readmissions, and 90-day complications.
METHODS
An institutional review board-approved retrospective cohort study was performed using institutional data. Two cohorts were created for patients who underwent either open reduction and internal fixation (ORIF) or arthroplasty (total or hemiarthroplasty) for a hip fracture in 2016 to 2023 in a multihospital academic health system. Within each cohort, patients with non-English and English PSL were matched 1:3 based on age, sex, insurance, American Society of Anesthesiologists Classification, dementia, and obesity. Generalized linear models measured associations between PSL and outcomes, adjusting for Charlson Comorbidity Index; adjusted odds ratios are reported for binary outcomes and adjusted mean differences are reported for continuous outcomes.
RESULTS
The matched cohorts included 729 patients undergoing ORIF and 473 undergoing arthroplasty. In multivariable analyses in the ORIF cohort, non-English PSL (versus English) was associated with a markedly longer LOS by an average of 0.95 days (95% confidence interval [CI], 0.28 to 1.62, P = 0.01) and decreased likelihood of discharge to a nonhome setting (odds ratio = 0.62, 95% confidence interval, 0.39 to 0.98, P = 0.04). For arthroplasty, non-English PSL (versus English) was markedly associated with shorter LOS by an average of 1.04 days (95% CI, -1.99 to -0.09, P = 0.03). No notable associations were identified between PSL and the other outcomes.
CONCLUSION
These findings suggest language-based differences in perioperative outcomes for surgical management of hip fracture. Further research is needed to identify the mechanisms of these associations and evaluate the clinical significance on long-term outcomes.
引言
最近，患者的主要口语语言（PSL）的作用已成为围手术期结果的一个潜在影响因素。本研究旨在确定患者的PSL与髋部骨折围手术期结果之间的关联，包括住院时间（LOS）、院内死亡率、非家庭出院、30天急诊科就诊、90天再入院率和90天并发症。
方法
使用机构数据进行了一项经机构审查委员会批准的回顾性队列研究。在一个多医院学术医疗系统中，为2016年至2023年因髋部骨折接受切开复位内固定术（ORIF）或关节成形术（全髋关节置换术或半髋关节置换术）的患者创建了两个队列。在每个队列中，根据年龄、性别、保险、美国麻醉医师协会分级、痴呆和肥胖情况，将非英语和英语PSL的患者按1:3进行匹配。使用广义线性模型测量PSL与结果之间的关联，并根据查尔森合并症指数进行调整；二元结果报告调整后的比值比，连续结果报告调整后的平均差异。
结果
匹配队列包括729例接受ORIF的患者和473例接受关节成形术的患者。在ORIF队列的多变量分析中，非英语PSL（与英语相比）与明显更长的住院时间相关，平均延长0.95天（95%置信区间[CI]为0.28至1.62，P = 0.01），且出院至非家庭环境的可能性降低（比值比 = 0.62，95%置信区间为0.39至0.98，P = 0.04）。对于关节成形术，非英语PSL（与英语相比）与明显更短的住院时间相关，平均缩短1.04天（95% CI为 -1.99至 -0.09，P = 0.03）。未发现PSL与其他结果之间存在显著关联。
结论
这些发现表明，髋部骨折手术治疗的围手术期结果存在基于语言的差异。需要进一步研究以确定这些关联的机制，并评估其对长期结果的临床意义。
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